230 Background: Developing and maintaining a culture of safety and quality in delivering patient care is critical in the intensive care unit (ICU) especially an oncology ICU. Incorporating the Lean Six Sigma program into daily operations of the ICU achieves, simplifies, and sustains continuous improvement in the delivery of safe quality patient care. This program engages the ICU team through visual management of quality, safety, and budget indicators including medication scanning, falls, sharps exposure, infection prevention including blood stream, catheter, hospital and ventilator acquired pneumonias, venous embolism prevention, and staffing compliance. Methods: The initiative focused on stakeholder development to increase professional certifications, improve engagement through development and implementation of educational events, and enhance participation in monthly journal club. Discussion of evidence-based research projects aligned each shift with data, metrics, and outcomes. Cost containment through charge capture, reduction in wasted supplies, and appropriate level of care order was implemented. With the support of Lean Six Sigma, the lean daily management board came to life each shift. Results: Outcomes included medication scanning rates increasing from 94% to 99.5%. Hospital acquired infection and pressure ulcer rates remained 0%. Venous thromboembolism prophylaxis rates increased form 77% to 100%. Staffing compliance increased from 90% to 100%. The number of chemotherapy certified nurses increased from 56% to 71%. The number of nurses with specialty certification improved from 28% to 47%. Stakeholders engaged in 32 professional educational events, and 12 journal clubs were led by the ICU nurses. Product charge capture began at $0 ending in an average of $1342 per month from 0% charge capture to 100% charge capture each month. Conclusions: Team alignment around daily production, patient flow, and staff development enables real-time problem solving around the daily issues of safety, quality, productivity, and stakeholder development. In this oncology critical care unit it has not only enhanced daily communication but every twelve hour shift engagement as well.